The Brazilian Journal of Infectious Diseases The Brazilian Journal of Infectious Diseases
Braz J Infect Dis 2017;21:209-10 - Vol. 21 Num.2 DOI: 10.1016/j.bjid.2016.11.010
Letter to the Editor
Arrhythmias in leptospirosis-associated acute kidney injury: a case series
Douglas de Sousa Soaresa,, , Gabriela Studart Galdinoa, Bruna Custódio Rodriguesa, Geraldo Bezerra da Silva Juniorb, Elizabeth De Francesco Dahera
a Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Medicina Interna, Fortaleza, CE, Brazil
b Universidade de Fortaleza, Faculdade de Medicina, Centro de Ciências da Saúde, Fortaleza, CE, Brazil
Received 05 October 2016, Accepted 26 November 2016
Dear Editor,

Leptospirosis is a zoonotic disease of global importance and a major public health problem, which is transmitted to humans by contact with mammals’ contaminated urine, most often rats.1 Its severe form manifests as jaundice, acute kidney injury (AKI), and hemorrhage, particularly in the lungs.2 Arrhythmias are the most important cardiac manifestations of this disease, and they have been described as risk factors for death.3 Herein we present clinical, demographic, and laboratory characteristics from a series of patients with leptospirosis admitted to a tertiary hospital in Fortaleza, Ceará, Brazil, from January 1985 to December 2015 who presented AKI and electrocardiographic (ECG) abnormalities. Among 488 leptospirosis patients, 24 (4.91%) presented arrhythmias, 23 acute atrial fibrillations and one atrial flutter. Most of them were young females (17–70.8%). All patients presented severe AKI, 16 (66.7%) needed hemodialysis, and nine patients (37.5%) died. They evidenced thrombocytopenia and high levels of AST, ALT and bilirubin, as summarized in Table 1. The patients were dehydrated on admission, due to vomiting, diarrhea, low fluid intake, polyuria, and excessive transpiration. In addition, hypokalemia, hypocalcemia and metabolic acidosis were noticed. These electrolyte abnormalities may have been a key point in the onset of arrhythmias, since they have been related to ECG abnormalities in leptospirosis, even when there is no myocardial dysfunction.4 Even though serum magnesium values were not available in patients’ charts, we believe that hypomagnesaemia may have also contributed to arrhythmias, as previously reported.5 In summary, dehydration and electrolyte disturbances were crucial to trigger arrhythmias in patients with leptospirosis. Therefore, these factors must be avoided or treated in order to prevent such life-threatening complications.

Table 1.

Demographic, clinical and laboratory data of leptospirosis patients with arrhythmias (n=24).

  Mean±SD/median/number (%)  Range 
Demographic and clinical data
Age (years)  46.2±13.4  (11–69) 
Time onset of symptoms to admission (days)  7.1±1.7  (5–10) 
Hospitalization time (days)  10.6±6.2  (1–24) 
Gender
Males  7 (29.2%)   
Females  17 (70.8%)   
Hemodialysis  16 (66.7%)   
Death  9 (37.5%)   
Laboratory data
Hemoglobin (g/dL)  10.1±1.6  6.5–12.3 
Hematocrit (%)  31.3±4.8  22–38 
Leukocytes (103/mm3)  16.83±10.07  4.5–52.6 
Platelets (103/mm3)  58.56±43.58  7.0–145.0 
Urea (mg/dL)  204.7±59.7  108–347 
Creatinine (mg/dL)  6.9±2.3  3.4–13.3 
Sodium (mEq/L)  132.0±6.0  124–144 
Potassium (mEq/L)  3.2±0.68  2.3–5.0 
Calcium (mEq/L)  7.5±2.4  6.4–11.0 
AST (U/L)  115.7±69.1  27–240 
ALT (U/L)  64.8±30.0  12–130 
Direct bilirubin (mg/dL)  16.0±7.9  4.3–31.0 
LDH (U/L)  714.2±214.4  380–1044 
CPK (U/L)  451.5±552.8  27–1609 
pH  7.36±0.06  7.25–7.48 
HCO3 (mEq/L)  18.6±4.6  12.8–28.9 

AST, aspartate aminotransferase; ALT, alanine aminotransferase; LDH, lactate dehydrogenase; CPK, creatine phosphokinase; HCO3, serum bicarbonate.

Variables were expressed as mean±standard deviation.

Conflicts of interest

The authors declare no conflicts of interest.

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Corresponding author.
Copyright © 2016. Sociedade Brasileira de Infectologia
Braz J Infect Dis 2017;21:209-10 - Vol. 21 Num.2 DOI: 10.1016/j.bjid.2016.11.010